NLS Minute – 8

– 8 –

Six extracts from the text

Who is Mad and Who is Not?
On Differential Diagnosis in Psychoanalysis

Pierre-Gilles Guéguen


(Read the full text in attach file, Reprint from Culture and Clinic , Minnesota press, Issue N°1, 2013)

Extract 1

There is a cross fertilizing movement at play
between two streams of thought all along thework of Lacan. On one hand, in the
name of psychoanalysis, he discards any kind of segregation of our fellow
humans (for example when he defines madness as the essence of human liberty in
his first Écrits or when he proclaims
in 1976 that “Everyone is mad”); this is the Lacan in favor of continuism. On
the other hand he tries to build up very precise definitions of what the
phenomena to be addressed through psychoanalysis might be: their logics, their
minute description, their clear-cut differences.


Extract 2

When Lacan says, “We are all mad, that is to
say, we are all delusional” one might take it as a strict equivalent of “we are
all psychotics”. If it were so, the option would totally be in favor of the
late Lacan and erase the first part of his teaching. It emerges as extremely
important to stress the very subtle way in which J.-A. Miller comments on this
sentence. His indications in this matter are fundamental since they have
bearings on the very practice of analysis.

In his last lecture of the year 2008, he takes
a very clear standpoint: “The madness at stake here, this generic madness, is
general, or rather universal. It is not psychosis. Psychosis is a category from
the clinic with which we try to capture something which anyway inscribes itself
in this very universal.” And Miller indicates that the signifier “delusional”
in this particular sentence of Lacan’s is to be understood as: “taken within
the network of meaning” (which cannot be avoided since human beings are
captured within the network of language).


Extract 3

Within the Freudian Field the debate on
un-triggered psychosis turned out to be a widely shared concern in 1998 when
the category of Ordinary Psychosis was created by Jacques-Alain Miller during a
research program of the Sections Cliniques du Champ freudien.

The concept of ordinary psychosis was at first
of restrictive extension but became rapidly in vogue. In the beginning it was
presumed to concern only some rare cases in which the foreclosure of the Name
of the Father remained un-decidable. A consensus soon turned up that it was not
rare to have to deal with an indetermination in the diagnosis of a case even
after lengthy preliminary interviews. As a matter of fact there were already
hints of it in Lacan’s first teachings when he mentioned un-triggered
psychosis. And sometimes, even though psychosis is technically onset, it takes
very discreet forms (an isolated elementary phenomenon for example).

However in some Schools of the AMP from 2004 to
2008, the vogue for the category of ordinary psychosis – and it is a fact that
the increasing number of cases to be found is correlated with the ongoing
decline of the Name of the Father in our civilization – and the emphasis put on
rapid therapeutic effects in psychoanalytic treatment as developed in the
French psychoanalytical free clinics created by the École de la Cause
freudienne, produced an inflationist bubble of indecisive diagnosis and maybe
some disarray for many clinicians who did not see the point of using clinical
categories that were obsolete in modern psychiatry when the “new clinic in
fashion” was the clinics of the knots.


Extract 4

Some precision and reflection about the
overextension of “ordinary psychosis” was necessary. 
Miller presented these details in a lecture he
gave in English under the title “Ordinary Psychosis Revisited”. This text of
reorientation is to be read as a landmark and a turning point in our clinics.


Extract 5

In the same text Miller also indicates that in
the differential diagnosis of ordinary psychosis the clinician has to look for
a negative differential approach: if it is not a neurosis then it is a
psychosis although it is not triggered. He mentions that the most solid
reference to discriminate between ordinary psychosis and neurosis is Hysteria
for which there is a very sturdy structural apparatus in the Freudian and
Lacanian corpus.

Extract 6

The proposition: “We are all mad but we are not
all psychotics” should also be examined in light of the theory of generalized
foreclosure formulated by J.-A. Miller in 1986, since at first sight it seems
to object to it.


NLS Congress 2016
Dublin, 2nd and 3rd July 2016

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